Guide to Open Enrollment for health insurance for individuals and families

Health insurance can be a lifeline in times of need. But its intricacies often leave people confused and anxious. This can make purchasing a health plan during Open Enrollment feel overwhelming. Whether you're shopping for health coverage for the first time or reevaluating your current plan, being well-informed is key.

In this article, we’ll guide you through ten simple steps to help you choose a health insurance plan.

In this blog post, you'll learn:

• How the Open Enrollment period works.
• How to compare health plan options to find the best one for you.
• If you qualify for a special enrollment period.

1. Know where you can buy individual health insurance

The Affordable Care Act (ACA) created a competitive market for individual insurance known as the federal Health Insurance Marketplace, or HealthCare.gov. Individuals and families can get coverage during Open Enrollment through the ACA marketplace or through state-run marketplaces. You can also work with a broker or health insurance company directly or buy a plan from a private exchange.

If your employer uses PeopleKeep by Remodel Health to administer your ICHRA or QSEHRA benefit, you can shop for a health policy right from your user dashboard. In some cases, your employer might work with a broker to help you choose and enroll in a policy instead.

2. Understand the Open Enrollment period

Open Enrollment for health insurance is when individuals can enroll in or make changes to their health insurance plans.

Open Enrollment is a crucial time for individuals, especially those who may have experienced changes in their circumstances, such as:

• Job changes
• Family member additions
• Financial shifts

During Open Enrollment, people can sign up for new coverage, switch plans, or make adjustments to their existing policies without facing penalties or restrictions.

For most, Open Enrollment usually takes place in the fall, running from November 1 to January 15. However, due to a new final rule, the 2026 Open Enrollment Period¹ for 2027 coverage will begin on November 1, 2026, and end on December 15, 2026, for all states with public exchanges operating on the federal Health Insurance Marketplace.

Some states, like California and Rhode Island, have extended Open Enrollment periods. Make sure to check the annual window where you live each year. After 2025, Open Enrollment for state marketplaces will change to be no later than December 31.

Outside of Open Enrollment, individuals can only enroll in health insurance if they experience a qualifying life event. Qualifying life events include moving, marriage, and the birth of a child, to name a few. This makes the Open Enrollment period essential for accessing healthcare coverage.

If your employer offers you a QSEHRA or ICHRA for the first time outside of Open Enrollment, this creates a 60-day special enrollment period (SEP).

3. Gather necessary information

During the application period, you should have the following information on hand:

• Personal details like your name, ZIP code, and Social Security number to verify your identity. You'll also need the Social Security numbers for all household members you plan to include under your policy.
• Income details (such as W-2 forms or pay stubs). This helps the Marketplace determine eligibility for subsidies or specific plan options.
• Information about your current health insurance plan, if you have one already.
• Any relevant medical records or documentation to determine the best plan for your needs. Individual health plans don’t take pre-existing conditions into account, so you won’t be denied coverage for them. However, tobacco use can impact how much you’ll pay.
• Preferred healthcare providers and specialists to ensure they’re in-network and covered under the selected plan.

4. Evaluate your current health needs

Before enrolling, assess your healthcare needs. Are you generally healthy? Or do you have chronic health issues?

Consider factors such as:

• The number of doctor visits you have annually
• Any ongoing medical conditions
• Necessary prescriptions

This will help you choose a plan that best fits your requirements during Open Enrollment.

5. Consider your healthcare providers

When picking a health insurance plan, you want to consider healthcare providers for several reasons. First, your choice of providers impacts the accessibility and quality of medical care you receive. Different insurance plans have varying networks of doctors, specialists, and hospitals. Choosing a plan that includes your preferred healthcare providers can ensure continuity of care.

Second, out-of-network providers often incur higher out-of-pocket expenses. This can lead to unexpected costs. By examining the provider network associated with each health plan, you can avoid situations where you face additional fees for seeking care outside the network.

Lastly, some plans offer more resources or benefits based on their provider relationships, such as coordinated care programs, preventive services, and specialized treatment options. By considering these additional details when choosing a plan, you can secure a system that aligns with your health needs and maximizes your insurance benefits.

6. Check for eligibility for health insurance subsidies

Depending on your annual income, you may qualify for premium tax credits², also known as health insurance subsidies. Many individuals and families may qualify for subsidies based on their income level and household size. These extra savings can result in lower monthly premium rates and out-of-pocket costs for medical services.

However, you can only qualify for tax credits and subsidies if you use the public or state-run marketplaces.

By understanding eligibility requirements, you can effectively compare different health insurance plans. This helps you choose one that meets your needs while staying within your budget. If you don't check if you qualify for tax credits, you're missing out on potential financial assistance for healthcare costs, which affects your overall well-being and financial stability.

If your employer offers you an affordable QSEHRA or ICHRA allowance, you can’t collect any premium tax credits. However, if your ICHRA is unaffordable, you can opt out of the benefit and collect any tax credits you qualify for. With an unaffordable QSEHRA, you must reduce any tax credits by the amount of your allowance.

7. Learn key health insurance terms

When searching for a plan during Open Enrollment, you'll likely come across various terms you haven't heard before. You'll want to ensure you understand these terms before selecting a plan.

Some common health insurance terms include:

• Deductibles
• Coinsurance
• Copayments or copays
• Health maintenance organizations (HMOs)
• Preferred provider organizations (PPOs)
• Point of service plans (POSs)
• Exclusive provider organizations (EPOs)

8. Research a variety of health insurance plans and compare costs

Research the various insurance plans available in your area. You can typically do this through federal or state-run marketplaces. Before you buy individual health insurance, you should familiarize yourself with the various metallic tiers of plans.

There are four metal levels of health insurance plans, ranked from lowest to highest premium cost:

• Bronze plans
• Silver plans
• Gold plans
• Platinum plans

Although all ACA marketplace plans provide the ten essential health benefits, they vary in terms of what you pay and what your health insurer covers for healthcare expenses.

Don't just look at health insurance premiums. If so, you might be swayed by a plan with a cheaper monthly premium that may cost you more in the long run. You also want to consider other costs associated with the plan, such as deductibles, copayments, and the provider network. A lower premium rate might mean higher out-of-pocket costs when you need medical care.

If your employer offers you a health reimbursement arrangement (HRA) like an individual coverage HRA (ICHRA) or a qualified small employer HRA (QSEHRA), you also need to consider which plans you need to participate in the benefit. In both cases, you'll need a health plan that meets minimum essential coverage (MEC) standards. However, the ICHRA requires you to have a qualifying individual plan, while the QSEHRA only requires MEC. All health insurance plans on the public exchanges meet this standard, but those available directly from a carrier may not.

9. Enroll online or seek help

During Open Enrollment, you can enroll online through the healthcare marketplace or with an insurance company. However, if you prefer assistance or have enrollment questions, consider working with a health insurance broker or health benefits navigator. Both brokers and navigators can help you apply for premium tax credits and compare marketplace plans for free.

10. Take note of special enrollment periods

If you miss the Open Enrollment period, you may still be able to sign up for or change your coverage if you qualify for a special enrollment period (SEP) due to life events.

The four basic types of qualifying events are:

• Loss of health coverage
• Offer of a new health benefit
• Changes in household
• Changes in residence

You also qualify for an SEP if you:

• Gain membership in a federally recognized tribe
• Become an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
• Begin or end service with AmeriCorps State, AmeriCorps National, VISTA, or NCCC

Additionally, you may be eligible for a SEP if you qualified in the past 60 days but missed your health plan enrollment deadline because of a natural disaster or a national or state emergency³.

There's also a low-income SEP for those struggling financially, but it's currently paused by the new final rule. It may return for the 2027 plan year.

What to do after you purchase a health insurance plan

Once you sign up during Open Enrollment, make sure to check your health coverage every year. Your health needs or financial situation may change, and it's wise to reassess your options each open enrollment period to make sure you have the best plan for your circumstances. You should also set a reminder for when the next open enrollment period begins. This helps you stay updated and ready to adjust your health insurance coverage if necessary.

After you enroll, you should also keep copies of your enrollment forms and any communication with your insurance provider. This documentation can be helpful in case of any discrepancies or issues regarding your coverage.

Additionally, your employer may require proof of your insurance coverage if they offer an HRA as a health benefit. With an HRA, your employer can reimburse you for monthly insurance premiums. This way, they can help you with your own individual insurance coverage instead of buying a group plan for the entire workforce. You can also receive reimbursement for more than 200 other HRA-eligible out-of-pocket costs.

Conclusion

You're not alone if you're worried about picking the right health insurance plan. There are many factors to think about, and the whole process can feel somewhat daunting. By following these steps, you can navigate Open Enrollment with confidence, ensuring you choose the right health insurance plan for you and your family.

1. https://www.healthinsurance.org/blog/new-federal-rule-brings-immediate-changes-to-marketplace-enrollment/#rule
2. https://www.irs.gov/affordable-care-act/individuals-and-families/questions-and-answers-on-the-premium-tax-credit
3. https://www.healthcare.gov/sep-list